Re: [pronut-hiv] Supplementation for moderatelymalnourished HIV-infected children - Share your experience (2)

["Basil Kransdorff" <basilb@iafrica.com>]

Hi Alice,

GREAT idea.

Here is some real feedback from a real project  we supplied our 
nutritional food supplement to.  Please note - what is important 
about this feedback is to better understand what is the cause of 
such an amazing effect in such a short period.  We explain some of 
these issues on bio-availability of important nutrients that are used 
in appropriate quantities.  Also important I believe is the 30 
nutrient type approach which overcomes single nutrient type 
approaches that ignore and often do not take into account combined 
inter nutrient interactions that are often left out of interventions 
and formulations.

What is a fact and a reality - it is not possible to achieve such 
stunning results with traditionally used nutrients and approaches 
often implemented on vast scales at enormous cost to the 
International Community.

Please note - In the context of the PLUMPINUT debate - it is not 
necessary for a RUTF to use expensive milk powder and large 
quantities of sugar and oil to achieve improved body mass and energy. 
Cost - between US$3 and US$10 a month depending on the transport 
component and body mass of the child.

Project GODE in SOMALIA run by ADRA

Dear Basil:

I can tell you my observation.

The ePap was distributed to 250 children and adults in Gode Hospital. 
Some of the beneficiaries were people living with HIV/AIDS and most 
of them were severely  malnourished women and children with medical 
complication and were admitted to the Hospital for more than a month. 
Several of them were outpatient. We have seen dramatic changes with 
most of the beneficiaries. There was very significant weight gain, 
improved appetite and very good medical response to the medicine that 
they were taking as compared with those who were not taking ePap. I 
have seen a child for example who is 8 years old and weighs 11kg!! he 
was not able to walk for several months,  and was being considered as 
neurologically incapable of walking. I saw him three weeks after ePap 
treatment and did a medical examination. I found his nervous system 
functioning well and he was able to stand up with out support and 
walk with a support. He was improving very fast. The reason he was 
not walking, I learned, was he has no muscle mass to support him to 
stand and walk. I later learned that the child walked out of 
hospital. There are many such case studies that I remember of. The 
monitoring in the hospital was excellent, with good follow up. It was 
distributed in daily basis. Those who were discharged out of the 
hospital used to come daily to the distribution place.

Regards

Mesfin H
Kind Regards,

Basil Kransdorff
basilb@iafrica.com


----Alice Ojwang-Ndong wrote:


>Dear Pronut Forum,
>I completely agree with Dr. Mwadime. Experience is the best teacher. 
>So lets share these experiences and stop recommending all those 
>Costly Abbot  products and the likes because even you cannot sustain 
>consumption of them. But we are talking about the low income person, 
>is more affected than the middle and high income group. Let's be 
>realistic. There are so many relief work going on with WFP and other 
>organizations, if they belong to this forum, can they please share 
>their experiences. I am personally  benefiting from this discussion.
>
>I do a lot of radio and television education, for Kenya and BBC 
>world service. What will I tell that mother who is listening and is 
>living a in remote region where there is no relief food or some kind 
>people to distribute the plumpy nut and the like. How about the 
>mother whose child is not HIV and does not meet the criteria for 
>food by prescription?. 99% of the time, we need to be very practical 
>realistic and make recommendations that are cheap and sustainable.
>
>Thanks you, I am reading on.
>
>
>Alice Ojwang-Ndong
>MNutr (Stellenbosch), Nutrition and Dietetic Consultant
>Center for Nutrition, Education and Research
>P.O.Box 8105 - 00200 Nairobi
>Kenya
>===============================
>Tel: +254-2-2711447 (direct)
>Cell: +254-721939067
>Email: Cener@wananchi.com/xenihealth@wananchi.com
>Website: www.xenihealth.com
>" Healthier choices, longer lives"
>
>
>-- Dr. Robert Mwadime wrote:
>
>   Friends,
>
>   I think this forum will benefit more from field examples and experiences,
>   rather than "theories and wishful thinking". Lets share experiences that
>   have worked or not worked. For example Lungi could share with us where they
>   are using the "positive deviance model" to address moderate 
> malnutrition and
>   it has worked effectively in the context of HIV. Or examples of where RUTF
>   was used to treat severe malnutrition and it was not sustainable. George
>   could tell us where Plumpynut has been used among PLHIV and it resulted in
>   increased diarrhea or oral thrush among people living with HIV; and what
>   they did about. Otherwise we shall not move-forward to solving the
>   nutritional problems in Africa/Asia.
>
>
>   Robert Mwadime (PHD)
>   Regional Senior Nutrion and HIV/AIDS Advisor
>   Academy for Education Development (AED)
>   Food and Nutrition Technical Assistance (FANTA) Project
>   c/o Regional Centre for Quality of Health Care,
>   P. O. Box 29140 Kampala, Uganda
>   Tel: +256-772-517438, 752-587635, 414-530888
>   www.fantaproject/www.aed.org
>
>   -----Lungi Lumumba Okoko wrote:
>
>   Dear all,
>
>   Why not not use local food and knowledge to rehabilitate moderately
>   malnourished children, instead of using food aid (in the form of PlumpyNut
>   and others)?
>
>   What happens when PlumpyNut or whey protein is no longer available to the
>   community? How will they rehabilitate malnourished children if they have
>   been taught to think that external food is the cure?
>
>   In my opinion, using behavior change approaches, such as the positive
>   deviance/hearth approach would be more sustainable. Even with HIV infected
>   children, some mothers (or caregivers) engage in behaviors and practices
>   that result in good nutritional outcome for child succeed. Why not use the
>   positively deviant caregivers as models to teach mothers of moderately
>   malnourished children new locally acceptable and affordable practices in
>   terms of feeding, care, and hygiene?
>
>   For more on positive deviance visit: http://www.positivedeviance.org/
>
>   -Lungi
>
>
>   ------ George Carter  wrote:
>   >
>   > Geoffrey - wow!! The dreadful thing to many outside Africa is the
>   > notion that Plumpynut sounds like the better than abject starvation
>   > so many face--but you are absolutely correct. And a high fat
>   > intervention for people with HIV can be problematic with all the
>   > attendant gut problems (let alone high sugar feeding candida).
>   >
>   > Which brings me back to the notion of a fortified whey protein (or
>   > some such protein source). What I think we know is needed is high
>   > protein and micronutrient repletion. At least from a nutritional
>   > standpoint - let alone the need for things like gardens, fresh
>   > vegetables, reinvigoration of older farming techniques that use
>   > forests and don't burn them for corn for diesel.
>   >
>   > We need a lot in this world but we're not going to ever get it in
>   > Africa. What do African kids want? What do their (still living)
>   > parents and guardians need?
>   >
>   > I think Plumpynut does remain a bit better than nothing. Hey--in the West
>   > you can make garbage like that and sell it for an outrageous price--you
>   > don't get  shot. You get rewarded!
>   >
>   > George M. Carter
>   >
>   >
>